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ENC2016-00238
Print Form CITY OF CA t'� ENCROACHMENT PERMIT Permit No DEPT. OF PI�AiK (for working within the public X-Ref. File 70 North First Street r ght-of-way) Application Date Campbell, CA 950FC 2 2016 Issued Application Expiration Date Ph. (408) 866-2150 APN Z,L CD Fx. (408) 376-0958 Public Works Administration Permit Expiration Date APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application expires in six (6) months if the permit is not issued. Application Fee is neon -refundable.) A. Work Address or Tract No.: zo ?milU East Hacienda Avenue Utility Trench Location: N/A B. Nature of work: Repair sidewalk, replace truncated domes, and additional signage C. Attach four (4) copies of an engineered plan showing the location and extent of the work, and four (4) copies of the preliminary Engineer's Estimate of work. The plans shall show the relation of the proposed work to existing surface and underground improvements. When approved by the City Engineer, said plan becomes a part of this permit. D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction; the General Permit Conditions listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and provisions may result in job shutdown and/or forfeiture of Faithful Performance Sureties and cash deposits. (See General Permit Conditions 1 and 2.) E. The Contractor must have this permit and approved plans at the site and must notify the Public Works Department at least two days before starting work. Notice must be given to Public Works at (east 24 hours before restarting any work. Name of Applicant: Jim Fulton Telephone: 408-496-0676 Address: 99 Almaden Boulevard, Suite 840, San Jose, CA 95113 ' ------------------- -1� C1►. E-Mail Address: jimf@arctecinc.com 21UB�MFGENC�YHDiE(U6+18i: f% Is this work being done by the property owners at their own residence? r" YES r NO The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents, and employees free, safe and harmless from any claim or demand for damages resulting from the work covered by this permit. The Applicant/Permittee hereby acknowledges that they have read and understand both the front and back of this permit, and they will inform their contractor(s) of the information. Applicant is advised that upon issuance of this permit, property owner, or property owner's successors, shall be responsible for any and all damages arisi gput of tlee edpclition of any private improvements in the public right-of-way. Accepted: Permittee) (sign) I SPECIAL PROVISIONS: 1. Street shall not be open cut for underground installations. Minimum cuts may be allowed for connections or exploration holes. Such cuts may be specifically approved by the Inspector prior to cutting. 2. Pavement may be cut for underground installations and must be restored in accordance with the Standard Details Trench Restoration Method "A", unless otherwise approved by the Engineer. 3. Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the cut sheets sent to the Public Works Department before starting work. 4. Per Section 4216 of the Government Code this permit is not valid for excavations until Underground Service Alert (USA) has been notified and the inquiry identification number has been entered hereon. USA Phone: 1-800-227-2600. USA TICKET NO. 5. Prior to any work, the property owner shall execute an Agreement for Private Improvements in the Public Right -of -Way, which shall be recorded. 6. Public Notification Requirements: SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AM U IT R EIPT PERMIT APPLICATION FEE $ 03 r I (J 7J PLAN CHECK DEPOSIT $ — SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS $ CONSTRUCTION CASH DEPOSIT PLAN CHECK & INSPECTION FEE EMERGENCY PERMIT FEE r$ j APPROVED FOR ISSUANCE E9 For Ciry Engineer Date Permit Expires 12 Months After Date of Issuance GENERAL PERMIT CONDITIONS 1. A Construction Cash Deposit is required. Charges will be made against this deposit if there is an emergency call -out, overtime inspection or when City ordered barricading is required. Any such costs in excess of the deposit will be billed to the Permittee. 2. A one-year maintenance period and surety are required. Such period will begin on date of written acceptance by the City. 3. Refund oi� the cash deposit balance and refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City. 4. Submit project schedule 10 (ten) days prior to proposed start of work. Special provisions may be required for work within City facilities and downtown Campbell. S. The Permittee must request in writing a final inspection and acceptance ofthe work upon completion. Acceptance by the City will be made in writing to the Permittee. 6. Maintain safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants, and water valves. 7. A Construction Traffic Control Plan and a Construction Schedule are required for all lane closures, detours, and street closures. This plan must be reviewed and approved prior to any lane closures. 8. A Construction Traffic Control Plan shall conform to the Caltrans Manual of Traffic Controls for Construction and Maintenance Work Zones, dated 1990, available at Caltrans. Traffic control equipment shall include Type II flashing arrow signs if required. 9. Replace as directed by the City Engineer any damaged or removed improvements in accordance with City Standards and Specifications at the sole expense of the Permittee. 10. Sawcut for all PCC or AC removals. All PCC removals shall be to the nearest scoremark and shall be doweled to existing improvements. 11. Prior approval of inspector is required for any work done after normal working hours, on weekends or holidays and may require reimbursement of inspection costs at the current overtime rate. 12. Adequate signing and barricading is required on thejob site. Failure to provide such signing and barricading may result in the City's providing signing and barricades and charging the cost (including all labor and materials) against the cash deposit. 13. Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer, 14. The Contractor or Permittee will have a supervisory representative available for contact on the project at all times during construction. Contractor or Permittee shall provide a phone number at which they can be contacted outside the hours of 8:00 a.m. to 4:00 p.m. 15. No storage of materials or equipment will be allowed near the edge of pavement, the traveled way, or within the shoulderline which would create a hazardous condition to the public. 16. This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any other work for which a separate permit may be required, nor does it relieve the Permittee of any obligation to obtain any other permit required by law. 17. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 18. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 19. Call back (call out) due to emeregencies regarding this permit shall be at the current overtime rate with a three (3) hour minimum charge per occurrence. 20. Pursuant to Chapter 14.02 of the Campbell Municipal Code, applicant shall not cause to be discharged any material into the municipal storm drain system other than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the Santa Clara Valley Urban Runoff Pollution Prevention Program. 21. If the public interest requires a modification of, or a departure from the plans and specifications, the City shall have the authority to require or approve any modification or departure and to specify the manner in which the same is to be made for City -owned or maintained facilities. 22. Permitttee must provide advance notification to all parties that may be affected by the permit activities. Notification shall be reviewed by the City prior to distribution and include dates of work and a contact name and phone number. Applicant shall be responsible for ensuring that all those providing services under the applicant are aware and understand all of the above conditions. Date: ilk it IS - 7 1:\FORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf Rev. 02/14 • • PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1, 2016 TO: Finance PUBLIC WORKS FILE NO. ENC2016- PROPERTY ADDRESS 250 E Hacienda Avenue Please collect & receipt for the following monies: ACCT. ITEM AMOUNT LAND DEVELOPMENT 4722 Encroachment Permit pp ica ion Fee Non -Utility Encroachment Permit Major >_$10,000 $403.00 $ 403.00 Minor Encroachment Permit <$10,00o $230.00 Initial R-1 Permit N/C Subsequent R-1 Permits within Two Year Period $230.00 Inspection Fee Minimum Charge per Location $398.00 Street Tree Planting/Removal N/C 2203 ($500 per Tree Planting Deposit Required) $500.00/tree 2203 Plan Check Deposit 2% of Engineer's Estimate $500.00 min $ 500.00 Utility and R-1 Permits no deposit required 4722 Grading & Drainage Plan Review Single Family Lot $281.00 Site < 10,000 s.f. $841.00 Site >_ 10,000 s.f. < 0.5 Acre $1,127.00 Site >_ 0.5 Acre $1,688.00 4722 NPDES Review C3 Requirements) For projects not required to submit numeric sizing $163.00 For projects required to submit numeric sizing Impervious Area 10,000 Sq. Ft to 1 Acre $704.00 Impervious Area 1 Acre or more $918.00 4722 For pro'ects sent to Consultant for review Consultant Cost +20% 4722 Additional treatment facilities $300 ea Plan Check & Inspection Fee (Non -Utility) 4722 Engr. Est. < $250,000 14% of Engineer's Estimate 4722 Engr. Est. >_$250,000 and 5$500,000 $35,000 + 8% of Engineers Estimate 4722 Engr. Est. >$500,000 $55,000 + 7% of Engineers Estimate 2203 Emergency Cash Deposit 4% of Engr. Est.* ($500 min/$10,000 Max) 2203 Faithful Performance Security (FPS) 100% of ENGR. EST.* 2203 Labor and Materials Security 100% of ENGR. EST.* 4721 Storm Drainage Area Fee Per Acre R-1 $2,120.00 (Multi -Res $2,385.00) (All Other $2,650.00) 4722 Parcel Ma 4 Lots or Less 4009.00 + 87/lot 4722 Final Tract Ma (5 or More Lots) $4,871.00 + 118/lot 2203 Monumentation Security 100% of Cit 's Monumentation Estimate 4920 Parkland Dedication Fee (75%/25% Due Upon Cert. of Occupancy) 4722 Lot Line Adjustment (includes Certificate of Compliance) $1,893.00 4722 Vacation of Public Streets & Easements $2,530.00 4722 Certificate of Compliance $1,877.00 4722 Certificate of Correction $561.00 4722 Document Recording Fees $15.00/first page $3 ea. Additional 4722 Private Improvement in Public ROW $50.00 4722 Approved Plan Revision Fee $100/sheet 4722 Appeal Filing Fee 1 $200.00 4722 Notary Fee(per signature) $10.00 4722 Assessment Segregation or Reapportionment First Split $895.00 Each Additional Lot $281.00 511.74241 MISCELLANEOUS' Postage .. - _. .._..... .. .. ... ... _. Other Please Specify) *Engineer's Estimate shall be as approved by the City Engineer and shall include all items of drk. TOTAL $ 903.00 NAME OF APPLICANT K� L �' 1 ►r V� ��i G (^ C. NAME OF PAYOR by1LL L� PHONE 56 Z, Q tt ADDRESS k/ (�QZIF , Id ` FOR RECEIVED B DEC 02 2019 ITY CLERK ONLY Date Receipt # 0 'p' d ' e �� _a� . ae J:V.,,0,,\P1m Check Canmen U-Speck Projects -Active P,,jectin P,,Tre \Hmi,,"Ave210\Inv,im 0- 1 PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1, 2016 TO: Finance PUBLIC WORKS FILE NO. ENC2016-238 PROPERTY ADDRESS 210/250 E Hacienda Avenue Please collect & receipt for the followingmonies: ACCT. ITEM" .,AMOUNT LAND DEVELOPMENT ncroac men Permit Fee' Non -Utility Encroachment Permit Major>$10,000 $403.00 Minor Encroachment Permit <$1o,000 $230.00 Initial R-1 Permit N/C Subse uent R-1 Permits within Two Year Period $230.00 Inspection Fee Minimum Charge per Location $398.00 Street Tree Planting/Removal N/C 2203 ($500 per Tree Planting Deposit Required) $500.00/tree 2203 Plan Check Deposit 2% of Engineer's Estimate $500.00 min 4722 Utility and R-1 Permits no deposit required (-- Grading & Drainage Plan Review ~ Single0 Lot Site < 10,000 s.f. $841.00 Site >_ 10,000 s.f. < 0.5 Acre $1,127.00 1� C Site >_ 0.5 Acre $1,688.00 NPDES Review C3 Requirements For projects not re uired to submit numeric sizing$163.00 For projects require to submit numeric sizing Impervious Area 10,000 S . Ft to 1 Acre $704.00� Impervious Area 1 Acre or more $918.00 For projects sent to Consultant for review Consultant Cost +20% -- Additional treatment facilities $300 ea �+ Plan Check & Inspection Fee(Non-Utility) En r. Est. < $250,000 14% of Engineer's Estimate Engr. Est. >_$250,000 and <_$500,000 $35,000 + 8% of Engineers Estimate En r. Est. >$500,000 $55,000 + 7% of Engineers Estimate Emergency Cash Deposit 47o of Engn Est.* ($500 min/$10,000 Max) Faithful Performance Security FPS 100% of ENGR. EST.* 4722 4722 4722 4722 4722 4722 2203 2203 2203 Labor and Materials Securit 100% of ENGR. EST.* 4721 Storm Drainage Area Fee Per Acre R-1 $2 120 00 4722 4722 2203ation 4920edication (Multi -Res $2,385.00) All Other $2,650.00 4 Lots or Less 4009.00 + 87/lot Ma 5 or More Lots 4,871.00 + 118 lot MIVIonumentation Securi 100% of Cit 's Monumentation Estimate Fee 75%/25% Due U on Cert. of Occu anc4722 UStment (Includes Certificate of Compliance) $1,893.00 4722f 4722 Public Streets & Easements $2,530.00 Certificate of Co m Hance $1,877.00 $ 2,530.00 4722 Certificate of Correction $561.00 4722 4722 Document Recording Fees $15.00/first page $3 ea. Additional Private Improvement in Public ROW $50.00 4722 Approved Plan Revision Fee $100/sheet 4722 Appeal Filing Fee $200.00 4722 Notary Fee(per signature) $10.00 Assessment Segregation or eapportionment First Split $895 00 [511T.7424Posta�ge Each Additional Lot $281.00 S.CS Other Please S ecif *Engineer's Estimate shall be as approved by the gity Engineer and shall include all items of work. TOTAL $• 2,530.00 NAME OF APPLICANT NAME OF PAYOR P.d-IbNE - ADDRESS ZIP ;; FOR RECEIVED Y. CITY CLERK ONLY r d r Date Receipt #" 0 J:1L.M-Wl-Check Canine l- Specific Proje Acfne Project m Plyre Selo Ave250N� end Sde kEaeft,dce l ® CERTIFICATE OF LIABILITY INSURANCE A�'vRo DATE(MM/DD/Yvvv) 3/22/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Asero Insurance Services 200 N. Almaden Blvd. 3rd Floor San Jose, CA 95110 CONTACT NAME: Asero Insurance Services P"c°NNo Ext: 866-966-8928 (FAX No: 408-271-1802 E-MAIL ADDRESS: certS asero ins. corn INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Allied World Assurance Co U.S. Inc. 19489 www.aseroins.com License No. OA91339 INSURED S B C C, I N C DBA South Bay Construction 1711 Dell Avenue INSURER B: Travelers Property Casualty Co of Amer 25674 INSURER C: Continental Insurance Company 35289 INSURER D : Campbell CA 95008 INSURER E: INSURER F : rnvFRanFR CFRTIFIC®TF NIIMRFR• ad7AF'Aud RFVISION NUMRF_R- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR OF INSURANCE ADDTYPE INSO WVD POLICY NUMBER EFF MM DDIYYYY MMIPOLICY Y EXP DDIIYYYY LIMITS A ✓ COMMERCIALGENERALLIABILITY ✓ �/ 0309-4606 3/1/2017 3/1/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ❑✓ OCCUR DAMAGE To TED PREMISES Ea occurrence) $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 0 PRO- JECT LOC PRODUCTS- COMP/OP AGG $ 2,000,000 1 $ OTHER: B AUTOMOBILE LIABILITY ✓ ✓ DT-810-8G380993-TIL-17 3/1/2017 3/1/2018 Ee aocideDtSINGLE LIMIT $ 1'000r000 BODILY INJURY (Per person) $ ✓ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED ✓ AUTOS ONLY ✓ AUTOS ONLY PROPERTY DAMAGE Per accident $ $ B ✓ UMBRELLA LIAB �/ OCCUR ZUP-15S20818-17-NF 3/1/2017 3/1/2018 EACH OCCURRENCE $ 5 000 000 AGGREGATE $ 51000,000 EXCESS LIAB CLAIMS -MADE DED I ✓ RETENTION $10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE —7 ✓ DT-JUB-8G380993-3-17 3/1/2017 3/1/2018 �/ STATUTE EOR" E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Leased/Rented Equipment 6024085132 3/1/2017 $500,000 13/1/2018�'Limit: Dedt: $ 1,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: #3119 Permit #ENC 2016-238; 210 Hacienda Offsite; 210 E. Hacienda Ave., Campbell, CA 95008 City of Campbell, its officers, employees and volunteers are named as additional insureds. Insurance is Primary where required by written contract. Thirty days notice of cancellation laK I II-IGA 1 t HULUtK V'_awlGANGtLLA I IUN #3119 Permit #ENC 2016-238 City of Campbell ��c�<ta�1OA THE UEXPIRATION LD ANY OF HDATE VT THEREOF, NOTICE E DESCRIBED I WILL ES BE CBECDELVERED ELLED BEFORE 70 N. First Campbell Sttreet 95008 h �t)�ks Pam` ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Marko Trapani ACORD 25 (2016/03) 9 19BB-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 34765384 117/18 All Lines I Janelle Manalo 13/22/2017 4:11:26 PM (PDT) I Page 1 of 6 AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED SBCC,I Asero Insurance Services DBA SouthNBCay Construction 1711 Dell Avenue POLICY NUMBER Campbell CA 95008 CARRIER NAIC CODE EFFECTIVE DATE: AUUI I IUPiAL KCIVIAKnJ THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) HOLDER: City of Campbell ADDRESS: 70 N. First Street Campbell CA 95008 General Liability Additional Insured as required by written contract per form CG 20 10 07 04 and CG 20 37 07 04 General Liability Insurance if Primary and Non -Contributory as required by written contract per form GL 00030 00 Workers' Compensation Waiver of Subrogation as required by written contract per form WC 99 03 76 (A) AI.UKU "IU"I (ZUUt51U-I) (02008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATTACHMENT 34765384 1 17/18 All Lines I Janelle Manalo 1 3/22/2017 4:11:26 PM (PDT) I Page 2 of 6 POLICY NUMBER: 0309-4606 COMMERCIAL GENERAL LIABILITY INSURED: South Bay Construction CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ izations : Locations Of Covered Operations (Where required by written contract) Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 34765384 1 17/18 All Lines i Janelle Manalo 1 3/22/2017 4:11:26 PM (PDT) i Page 3 of 6 Page 1 of 1 ❑ POLICY NUMBER: 0309-4606 COMMERCIAL GENERAL LIABILITY INSURED: South Bay Construction CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Oraanization(s): I Location And Description Of Completed Operations (Where required by written contract) Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ 34765384 1 17/18 All Lines I Sanelle Manalo 13/22/2017 4:11:26 PM (PDT) I Page 4 of 6 / WORKERS COMPENSATION TRAVELERS AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 ( A) — POLICY NUMBER: DT-JUB-8G380993-3-17 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description Blanket Waiver - Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 03-01-2017 3olicy No. DT-JUB-8G380993-3-17 :ndorsement No. Insured South Bay Construction Premium Insurance Company Travelers Prop Cas. Co. of Amer. Countersigned by DATE OF ISSUE: - - ST ASSIGN: Page 1 of 1 34765384 1 17/18 All Lines I Janelle Manalo 1 3/22/2017 4:11:26 PM (PDT) I Page 5 of 6 ' POLICY NUMBER: 0309-4606 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT (PRIMARY AND NON-CONTRIBUTORY WHERE REQUIRED UNDER CONTRACT) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Section II — Who Is An Insured is amended to include any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy. However, the insurance provided will not exceed the lesser of: a. The coverage and/or limits of this policy; or b. The coverage and/or limits required by said contract or agreement. Coverage afforded to these additional insured parties will be primary to, and non-contributory with, any other insurance available to that person or organization where required of you by written contract or agreement. GL 00030 00 (10/09) 34765384 1 17/18 All Lines 1 Janelle Manalo 1 3/22/2017 4:11:26 PM (PDT) I Page 6 of 6 INSURANCE REQUIREMENTS CHECKLIST Permit # C G -80ZS-$ . CIP Project # Consultant/Contractor: :50 - `�'l k3C_V%n — The following insurance is required of all, consultants/contractors working in the City of.,Campbell public right-of-way. Insurance certificates must be accepted. by City staff before work can begin. These insurance requirements apply to work being performed under an Encroachment - Permlt and worl< being performed under contract for Capital Improvement Projects. Limits Commercial.General Liability for bodily, personal injury and property damage: $1,000;000 per occurrence, and ❑ $1,000,000 general aggregate limit applying separately to the project, or $2,000,000 general aggregate limit. - ❑pL-Policy expiration date 3 Automotive Liability: 9( "Any Auto" checked on certificate .K $1,000,000 per accident for bodily injury and property damage 94 Policy expiration date 7v l Workers' Compensation and Employer's Liability Waiver of Subrogation clause ,Q� $1,000,000 per accident for bodily injury or disease jur.,Policy expiration date 3 1 t 1 l Course of Construction (if required in Special Provisions) ❑ Completed value of the project ❑ Policy expiration date Required Endorsements to General Liability and Automobile Liability Policies Additional Insured Endorsement: The City, its officers, employees and volunteers are named as additional insured. (Reference Project Location/Permit Number) et The insurance coverage afforded to the Additional Insured is primary insurance. Cancellation area: ❑ Cancellation area of certificate edited to delete "endeavor to" and "but failure to mail such notice shall impose no oblieation or liabilitv of anv kind upon the companv, its aaerits or representatives". OR should say: Should any of the above described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. ❑ Workers' Compensation Insurance Sheet Submitted * For General Contractor ❑ For Developer or Owner J:\FORMS\Templates\Insurance Requirements\Insurance Requirements Cklist.doc (Rev 08 14) Page 1 Acceptability of Insurer(s) ❑ Insurer(s) has current A.M. Best Rating of A:VII and is authorized to transact business in the State of California. Name: ����C a Woc NAIC # Rating: f-1 r Authorized in CA: Name: 'V" aCar_�C_<S NAIC # Z54191 Rating: �� Authorized in CA: Name: NAIC # Rating: Authorized in CA: Name: NAIC # Rating: Authorized in CA: ❑ Campbell Business License # 6$5LA 7, Expiration: ❑ Contractors License # 33 (01-1 \ Class: w Expiration: Insurance Certificate Reviewed Z n I tials Date Copy of Insurance Certificate placed in tickler file one month prior to expiration. J:\FORMS\Templates\Insurance Requirements\Insurance Requirements Cklist.doc (Rev 08 14) Page 2 Recording Requested By: City of Campbell And When Recorded Return To: City Clerk City of Campbell 70 N. First Street Campbell, CA 95008 23967196 Regina Alcomendras Santa Clara Countyy - Clerk -Recorder 05/29/201a 12:40 PfM CONFORMED COPY Copy of document recorded. Has not been compared with original. APN: 424-33-121, 424-33-120 (Space Above This Line For Recorder's Use Only) ADDRESS: 210 and 250 E. Hacienda Ave., Campbell, CA 95008 NOTICE OF RELEASE BY CITY OF CAMPBELL NOTICE IS HEREBY GIVEN concerning the real property located in the City of Campbell, Santa Clara County, California, and described specifically as follows: 210 and 250 E. Hacienda Avenue; Campbell, CA. That whereas, CRP VAS.ONA, LLC, a Delaware Limited Liability Company, eiatered into. a Street Improvement Agreement with the City of Campbell, recorded June 16, 2017, Document# 23645188, in the- Office of the County Recorder, County of Santa Clara, State of California. That, whereas, said conditions of said Agreement have been met to the satisfaction of the City. That, Now Therefore CRP VASONA LLC is hereby released from all requirements contained in the agreement recorded June 16, 2017, Document #23645.188, in said County Recorder's Office. IN WITNESS WHEREOF, said City has caused its name to be affixed by its City Engineer and City Clerk, who are duly authorized by Ordinance 2059 adopted September 20, fl � 2005. ATTEST: Wendy W , City Clerk (Attach Notary Acknowledgment) Amy O ay �v City E gineer, City of Campbell Dated: CALIFORN1A ALL-PURPOSE AcKNOWLED.GMENT CIVIL CODE § 118.9 A notary public or other officer completing this certificate verifies onlythe identity of the indiVidual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of7yL�O. On ��e- � 2 � `� before me, Dote. Here Insert Name and Title of the Offer personally appeared Norne(s) of Signer(s) . who proved to me on the basis of satisfactory evidence to be the person(S) whpse nariie.(s) Ware subscribed to the within instru).en't and 8gkhovviedged to rri:e that helshelthey executed the same in hislherltheir auihari_zed capacity(fes), and tha by hiSltierlthe r sigr�atufe(s� oil the instrument the person(s), or the entity. . :. . upon behalf of which the person($.) acted, 696,.(uted the instrument. JOANN TNQW9N. C:omrrrissioij # 2110789 z41,MV Notary Public - California a z Santa Clara County Comrti.:Exp`ire.s (Vlay 9' 2019 I certify under PENALTY OF PERJURY under the laws of the. State of California that the foregoing paragraph is.true aril correct. WITNESS my hand and official seal.. $ gnature A - Place Notary Seal andlor stamp Above. S •gna re of Notary Public OPTIONAL Completing this information ceri deter alteration of the document or , fraudulent redttochment of this form t6 an unintended document Description of Attached Document A Tide or Type of Document: ok c,- Os� Rrae e— Zl0-Z SO DocumentDate: NumberofPages: - Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signers) Signer's Name: ❑ Corporate Officer _ Title(s): ❑ Partner- ❑ Limited o General ❑ Individual ❑ Attorney in.Fact ❑ Trustee . ❑ Guardian of Conservator ❑ Other: Signer is Representing: 02017 National• • • Signer's Name: ❑ Corporate Officer - Titie(s): ❑ Partner - ❑ Limited ❑ General ❑ individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑. Other: Signer is Representing: a TO BE RECORDED WITHOUT FEE SECTION 6103 GOVERNMENT CODE AT THE REQUEST OF CITY OF CAMPBELL Recording Requested by: ) City of Campbell ) When recorded mail to: ) City Clerk ) City of Campbell ) 70 North First Street ) Campbell, CA 95008 ) 23645188 Regina Alcomendras Santa Clara County - Clerk -Recorder 05/10/2017 02:06 PM Titles: 1 Pages: 11 Fees: Roo .00 Taxes: Total: RECMEIVEC) `JUN 16 2017 CITY CLERK'S OFFICL NIIII WA, � k 11 VA461I 111 i,� F-) L aa, Cr, y `6J� APN: 424-33-121, 424-33-120 (Space above this line for Recorder's use only.) ADDRESS: 210 and 250 E Hacienda Ave, Campbell, CA 95008 STREET IMPROVEMENT AGREEMENT RECITALS THIS AGREEMENT, identified by File No(s). ENC2016-238, is entered into this 2 -7 day of kyb"-Vc_�, , 2017, by and between CRP VASONA, LLC, A DELAWARE LIMITED LIABILITY COMPANY, hereunder referred to as "Owner," and the CITY OF CAMPBELL, a municipal corporation of the County of Santa Clara, State of California, hereinafter referred to as "City." On October 25, 2016 the Planning Commission granted conditional approval of a Conditional Use Permit (PLN2016-140) to allow the establishment of a medical services clinic and pharmacy within the Vasona Technology Park (Building G) for that certain real property described in Exhibit A attached hereto and incorporated as though fully set forth herein, an commonly known as 210 and 250 E Hacienda Ave, which property is hereinafter referred to as "said real property." TERMS AND CONDITIONS Now, therefore, in consideration of the above referenced approvals, and in satisfaction thereof, the parties to this Agreement shall comply with the following terms and conditions: (1) The Owner shall provide, construct and install at his/her own proper cost and expense, ? street improvements as described in Section 11.24.040 of the City Code within 12 months from the date first mentioned hereinabove; provided, however, that in the computation of said 12 month period, delays due to, or caused by acts of God, viz., unusually inclement weather, major strikes, and other delays beyond the control of the Owner or his/her successors shall be excluded. (2) If the Owner fails to complete the work required by this Agreement within the said 12 month period, the City, after giving ten (10) days written notice to the Owner, or his/her successors, may construct and/or install said improvements and recover the full cost and expense from the Owner, or his/her successors. (Rev 09/15) 1 STREET IMPROVEMENT PLANS (3) The Owner, shall cause to be prepared at his/her cost and expense street improvement plans for the construction and installation of said improvements prior to such construction or installation. Said plans shall be prepared by a civil engineer registered by the State of California and submitted to the City Engineer for examination and approval. (4) All of said improvements embraced in this Agreement shall be constructed and installed in accordance with the plans approved by the City Engineer and shall be made under the inspection and to the satisfaction of the City Engineer. Said construction and/or installation shall be in accordance with the existing ordinances and resolutions of the City of Campbell and all applicable plans, specifications, standards, sizes, lines and grades approved by the City Engineer, and all State and County statutes. Upon completion and acceptance of the improvements by the City, the Owner, shall provide reproducible as - built plans to the City Engineer. PLAN CHECK AND INSPECTION FEE (5) Prior to approval of the plans by the City Engineer pursuant to Section (3) of this Agreement, Owner, or his/her successors, shall pay the City for plan checking of improvement plans, field inspection of construction of improvements and all necessary expenses incurred by City in connection with said improvements, a sum calculated in accordance with Resolution No. 10494 as adopted by the City Council on May 3, 2005, or as may subsequently be adopted by the City Council. FAITHFUL PERFORMANCE SECURITY (6) The Owner, or his/her successors, shall file with City, prior to beginning construction, security acceptable to the City in amount equal to the City Engineer's estimated cost of the street improvements to ensure full and faithful performance of the construction of all the aforementioned improvement work. Said security shall guarantee that Owner, and his/her successors, will correct any defects which may appear in said improvement work within one (1) year from the date of acceptance of the work by City and pay for any damage to other work resulting from the construction thereof, as well as pay the cost of all labor and materials involved. This security shall remain in effect until one (1) year after date of final acceptance of said improvements by City. Said security amount may be reduced by the City Engineer in his/her sole discretion after the date of final acceptance to not less than twenty-five (25) percent of its full value. (7) Upon final release of said security by City, the obligations of Owner, and his/her successors, contained in this Agreement shall be considered null and void, except as otherwise provided by applicable law, or Sections 12 or 13 of this Agreement. FORMATION OF A SPECIAL ASSESSMENT (8) The Owner, when called upon by City to do so, shall execute a petition for the formation of any special assessment district created pursuant to any special assessment act as (Rev 09/15) provided in the Streets and Highways Code of the State of California created for the purpose of constructing and/or installing any or all of said improvements. Owner, or his/her successors, shall participate in and become a part of any special assessment district as described in Section (8) of this Agreement. (9) The Owner's, or his/her successors' obligations contained in this Agreement that are accomplished to the satisfaction of said City Engineer by said special assessment district shall be considered to satisfy those obligations. RIGHT-OF-WAY ACQUISITION (10) Owner at his/her own cost and expense, shall acquire any easement and right-of-way within or without said real property necessary for the completion of the improvements shown upon aforesaid improvement plans. It is provided, however, that in the event eminent domain proceedings are required for the purpose of securing said easement and right-of-way, Owner, shall deposit or cause to be deposited with City a sum covering the reasonable market value of the land proposed to be taken and to be included in said sum shall be a reasonable allowance for severance damages, if any. It is further provided that in addition thereto such sums as may be required for legal fees and costs, engineering and other incidental costs shall be deposited with the City. (11) The Owner, shall carry out any and all negotiations with all interested parties and shall perform or cause to be performed at his/her own cost and expense and to the satisfaction of the City Engineer any and all work required to abandon, remove, raise, lower, relocate and otherwise modify irrigation lines within or without the boundary of said real property. INDEMNITY AND INSURANCE (12) The Owner, and his/her successors, to the fullest extent permitted by law, shall indemnify, defend and hold the City of Campbell, its agents, employees, attorneys, officers, officials and assignees harmless from any and all claims, actions, causes of action, liabilities, damages, losses and expenses, including, but not limited to, attorneys' fees, arising out of, or resulting from, or alleged to arise out of or result from any negligent or intentional act or omission (including misconduct) of said Owner, or his/her successors, or any subcontractor, or anyone directly or indirectly employed by him, or anyone for whose acts any of them may be liable in the course of performance of the Agreement, except for any claims, actions, causes of action, liabilities, damages, losses and expenses proximately caused by the sole negligence or willful misconduct of the City. (13) The Owner, and his/her successors, shall also indemnify, defend and hold the City of Campbell, its agents, attorneys, employees, officers, officials, and assignees harmless against and from any and all claims, actions, causes of action, liabilities, demands, losses, lawsuits, judgments, damages, costs and expenses (including, but not limited to, attorneys' fees and court costs, whether incurred at trial, appellate or administrative levels) which the City of Campbell may incur or suffer, or to which the City of Campbell 3 (Rev 09/15) may be subjected resulting from, or alleged to result from the failure of Owner, or his/her heirs, assignees, successors, grantees, agents, employees, subcontractors, or anyone performing services under him, to fulfill any of the obligations imposed under this Agreement, except for any claims, actions, causes of action, liabilities, judgments, damages, costs and expenses proximately caused by the sole negligence or willful misconduct of the City. (14) The Owner and his/her successors shall also indemnify, defend and hold harmless the City, its agents, officers and employees from any claim, action, or proceeding against the City or its agents, officers or employees to attach, set aside, void or annul an approval of the City, its City Council, Planning Commission, Community Development Director, Public Works Director, Building Official, City Engineer, or other such City official concerning a subdivision, which action is brought within the time period provided for in California Government Code Section 66499.37. (15) In the event that this contract is subject to California Civil Code section 2782(b), the foregoing indemnity provisions shall not apply to any liability for the active negligence of the City. The foregoing indemnity provisions are intended to fully allocate all risk of liability to third -parties. No other rights of indemnity or contribution shall exist between the parties in law or in equity. The provisions set forth in this section shall survive the termination of this Agreement. (16) The City will promptly notify the Owner of any claim, action or proceeding to attack, set aside, void or annul any approval concerning a subdivision of said real property, and will cooperate fully in the defense. (17) Owner and his/her/its successors shall maintain insurance for injuries to persons or damage to property conforming to the following specifications: A. Minimum Scope of Insurance Coverage shall be at least as broad as: 1. Insurance Services Office (ISO) CGL form CG 00 01 11 85; and 2. ISO form G0009 11 88 Owners and Contractors Protective Liability Coverage Form — Coverage for Operations of Designated Contractor; and 3. Course of Construction Insurance covering all risks of loss; and 4. ISO CA 00 01 06 92 including symbol 1 (Any Auto); and 5. Workers' Compensation insurance as required by the Labor Code of the State of California and Employer's Liability insurance. B. Minimum Limits of Insurance Owner shall maintain limits no less than: 4 (Rev 09/15) 1. General Liability: $1,000,000 combined single limit per occurrence for bodily, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. 2. Automobile Liability: $1,000,000 combined single limit per accident for bodily injury and property damage. 3. Workers' Compensation and Employer's Liability: Workers' Compensation limits as required by the Labor Code of the State of California and Employer's Liability limits of $1,000,000 per accident. It is a requirement of this Agreement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits set forth in this Agreement shall be available to the City as an additional insured. Furthermore, the requirements for coverage and limits shall be (1) the minimum coverage limits specified in this Agreement, or (2) the broader coverage and maximum limits of coverage of any insurance policy or proceeds available to the named insured, whichever affords greater coverage. The limits of insurance required in this Agreement may be satisfied by a combination of primary and umbrella or excess insurance. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary and non-contributory basis for the benefit of City (as agreed to in this Agreement) before the City's own insurance or self-insurance shall be called upon to protect it as a named insured. C. Deductible and Self -Insured Retention Any deductibles or self -insured retention must be declared to and approved by the City. At the option of the City, either: the insurer shall reduce or eliminate such deductibles or self -insured retention as respects the City, its agents, officers, attorneys, employees, officials and volunteers; or the Owner shall procure a bond guaranteeing payment of losses related to investigations, claim administration, and defense expenses. D. Other Insurance Provisions The policies are to contain, or be endorsed to contain, the following provisions: 1. General Liability and Automobile Liability Coverage: a. The City, its agents, officers, attorneys, employees, officials and volunteers are to be covered as insureds as respects: liability arising out of activities related to this Agreement performed by or on behalf of the Owner, products and completed operations of the Owner, premises owned, occupied or used by the Owner, or automobiles owned, leased, hired or borrowed by the Owner. (Rev 09/15) 5 b. The Owner's insurance coverage shall be primary insurance as respects the City, its agents, officers, attorneys, employees, officials and volunteers. Any insurance or self-insurance maintained by the City, its agents, officers, attorneys, employees, officials and volunteers shall be excess of the Owner's insurance and shall not contribute with it. C. Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, its agents, officers, attorneys, employees, officials, and -volunteers. d. The Owner's insurance shall apply separately to each insured against whom claim is made or suit is brought except with respect to the limits of the insurer's liability. e. Coverage shall not extend to any indemnity coverage for the active negligence of the City in any case where an agreement to indemnify the City would be invalid under Subdivision (b) of Section 2782 of the California Civil Code. 2. Workers' Compensation and Employer's Liability Coverage: The insurer shall agree to waive all rights of subrogation against the City, its agents, officers, attorneys, employees, officials, and volunteers for losses arising from work performed by the Owner for the City. 3. Course of Construction Coverage: Course of Construction policies shall contain the following provisions: (a) the City shall be named as loss payee; and (b) the insurer shall waive all rights of subrogation against the City. 4. All Coverages: Each insurance policy required by this clause shall be endorsed to state that coverage shall not be suspended, voided, canceled by either party, reduced in coverage or in limits except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. E. Acceptability of Insurers Without limiting Owner's indemnification provided hereunder, Owner shall take out and maintain at all times during the life of this contract, up to the date of acceptance of the work by the City, the policies of insurance listed in Paragraphs 12 through 16 of this Agreement. Insurance is to be issued by an issuer with a current A.M. Best Rating of A:VII and be authorized to transact business in the State of California, unless otherwise approved by the City. F. Verification of Coverage Owner shall furnish the City with certificates of insurance evidencing coverage required by this clause. The certificates for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf. The certificates are to be on forms provided by the City. Where by statue, the City 6 (Rev 09/15) Workers' Compensation related forms cannot be used, equivalent forms approved by the Insurance Commissioner are to be substituted. All certificates are to be received and approved by the City before work commences. G. Subcontractors Owner shall include all subcontractors as insured under its policies or shall furnish separate certificates by each subcontractor. All coverage shall be subject to all of the requirements stated herein. MUTUAL BENEFIT COVENANTS BINDING ON HEIRS ASSIGNEES SUCCESSORS AND GRANTEES OF OWNER (18) It is acknowledged that the provisions oK this Agreement constitute covenants for the improvement of the subject real property for the mutual benefit of Owner's property, commonly known as 210 and 250 E Hacienda Avenue, and the City's property, commonly described as Hacienda Avenue where it adjoins Owner's property. These covenants shall be considered to affect rights in the above -described real properties, and shall be binding on the heirs, assignees, successors, grantees and agents of the Owner to said real property. UNVESTED INTERESTS (19) Nothing contained herein shall be construed to transfer any unvested interests in real or personal property for purposes of the rule against perpetuities. BREACH OF CONTRACT (20) The City, upon breach any of the terms, conditions, or covenants of this Agreement by the Owners, shall be entitled to recover from the Owner, in addition to any other relief available in law or equity, all costs and compensation incurred in attempting to obtain enforcement of the Agreement, including reasonable attorneys' fees and court costs. ENTIRE AGREEMENT BINDING (21) This is the entire Agreement between the parties, and there are no representations, agreements, arrangements or understandings that are not fully expressed herein. This Agreement can be executed in counterparts by the parties hereto, and as so executed shall consist of one agreement, binding on all parties. PRELIMINARY PLANS (22) Owner shall provide and construct public street improvements per preliminary plans titled "STREET IWROVEMENT PLANS — OFFSITE — 210 and 250 E Hacienda Avenue," which are subject to approval by the City Engineer, prepared by Kier and Wright Civil Engineers and Surveyors. (Rev 09/15) IN WITNESS WHEREOF, said City has caused its name to be affixed by its Public Works Director and City Clerk, who are duly authorized by Ordinance 2059 adopted September 20, 2005, and said Owner has caused his/her name to be affixed the day and year first above written. Please see attached Notary Certificate. Attest: Wendy d, City Clerk OWNER CRP VASONA, LLC, A DELAWARE LIMITED LIABILITY COMPANY By. Name: David A. Kingery, Title: Vice President CITY OF CAMPBELL Todd Capurso, Public Works Director City of Campbell (Notary Acknowledgment for above signator(ies) MUST be attached.) 8 (Rev 09/15) CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT A Notary Public or other official completing this certificate verifies only the identity of the individual who signed the document to which- this certificate is attached and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA COUNTY OF CONTRA COSTA On M u/felt �� S 011 /� before me, Sean Tedlock, Notary Public, personally appeared 1 r 01/y`� �l 19 // Y who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)dPare subscribed to the within instrument and acknowled)'s to me tha�/she/they executed the same ir�/' her/their authorized capacity(ies), and that by her/their signature(s) on the instrument the person(s), or entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. SEAN TEDLOCK Notary Public - California Contra Costa County n otary Public ° Commission # 2147297 IUIy Comm. Expires Apr 19, 2020 Optional This certificate is attached to (tide or type of document), of _ (number) pages. Chicago Title Company EXHIBIT A LEGAL DESCRIPTION THE LAND REFERRED TO HEREIN BELOW IS SITUATED IN THE CITY OF CAMPBELL, IN THE COUNTY OF SANTA CLARA, STATE OF CALIFORNIA, AND IS DESCRIBED AS FOLLOWS: All of Parcels 1, 2, 3 and 4, as shown upon that certain Map entitled, "Parcel Map being a subdivision of Lots 2 and 5 as shown on that certain Map entitled, 'Mrs. W.J. Parr Tract' filed for record on December 19, 1890 in Book E of Maps, page 63, Santa Clara County Records", which Map was filed for record in the Office of the Recorder of the County of Santa Clara, State of California on October 30, 2000 in Book 733 of Maps, at pages 32 and 33. APN: 424-33-118, 424-33-120, 434-33-119, 434-33-121 CLTA Preliminary Report Form (Modified 11/17/06) Printed: 12/14/2016 4:19 PM by <<User Initials>> IPrelm (DSI Rev. 10/25/16) Page 3 Order No.: 15604139-156-TM1-MCI CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the . individual who signed the document .to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of 0 _k� C ,— } On ' i ca- \ before me, ( ere insen name ano Bue of the cer personally appeared n d S who ,proved to me on the basis of satisfa6tory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. JOANN THOMASON Commission # 2110789 WIT E z :'� Notary Public - California D Santa Clara County My Comm. Expires may 9, 2019 --_-� Notary (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) oa \O / '-;), 5 O la . Q.L. ev. N.-- (Title or descrition of attached document continued) Number of Pages Document Date CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer (Title) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other 2015 Version Lwtm,.NotaryClasses.corn 800-973-9865 INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, if needed, should be completed and attached to the document. Acknowledgments from other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California notary law. • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he/she/they,— is /are ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document with a staple. Encroachment Permit Final Sign Off Encroachment Permit # �' �f 6, OG 23 g Address: 2f c' C I`IAC,( Date of Final Inspection and Acceptance: Inspected by: OK to release deposits: 100% 75% �. Comments: �7 -Fps 000010 Nveo,-6�-Y\SSA e 6 c ,e�Doq waQ e� o,N of C,g4;t c •UkCHAK�• CITE' OF CAMPBELL Public Works Department June 12, 2018 Ms. Sandy Izumi, CBRE CRP Vasona, LLC. 225 W. Santa Clara St., 12th Floor San Jose, CA 95113 SUBJECT: PERMIT NO. ENC 2016-00238 250 E. Hacienda Ave.., Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Sandy: The City of Campbell has made the final inspection of the subject Pubtic Works improvements and finds that no remedial work is required. Your warranty requirements and any surety, therefore, are hereby released. Your Faithful Performance Bonds in the amount of $23,000.00 are enclosed. Sincerely, Syed Wahidi Public works Inspector CC: Marco Velasco, So. Bay Construction 70 North First Street • Campbell, California 95008-1436 • TEL 408.866.2150 • FAX 408.376.0958 • TDD 408.866.2790 Encroachment Permit Final Sign Off Encroachment Permit 2E' Address: 2.50 WACAUN� D/-,\• Date of Final Inspection and Acceptance: Inspected by: OK to release deposits: 100% 75.E Comments: {n�� J OF CA`�d+ •�RCHAR�•. _ CITY of CAMPBELL Public Works Department June 20, 2017 South Bay Construction 1711 Dell Ave. Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2016-00238 250 E. Hacienda Ave. FINAL; INSPECTION AND ACCEPTANCE To Whom It May Concern: The City of Campbell has made a final inspection of subject Public Works improvements and finds the, work to be acceptable and in conformance with City standards. Accordingly, the City Engineer accepts the improvements. The one year maintenance period stated in the permit begin's aC.ive 6, 2017. The permittee is responsible for the repair and/or replacement of awor failures that -occur within one year. The City will inspect the improvements within one year and notify you, in writing, whether or not any repairs are'required. Your Faithful Security Deposit in the amount of $23,000.00 and your Construction Cash Deposit for $920.00 is enclosed. If you have any questions, please call me at (408) 866-2165. Sincerely, t Syed A�Gahidi Public Works Inspector Cc: inspector/Suspense Files Permit File ENC2016-00238 70 North First Street • Campbell, California 95008-1436 • TEL 408.866,2150 • FAX 408:376.0958.• TDD 408,866.2790 oVC-14f A, A;d� • Hk CHARD • - CITY OF CAMPBELL Public Works Department July 11, 2017 Ms. Sandy Izumi, CBRE CRP Vasona, LLC 225 W. Santa clara Street, 12t" Floor. San Jose, CA 95113 SUBJECT: PERMIT NO. ENC 2016-00238 250 E. Hacienda Ave. FINAL INSPECTION AND ACCEPTANCE Dear Sandy: The City of Campbell has made a final inspection of subject Public Works improvements and finds the work to be acceptable and in conformance with City standards. Accordingly, the City Engineer accepts the improvements. Your Plan Check Deposit in the amount of $500.00 is enclosed. If you have any questions, please call me at (408) 866-2150. Vncr , E?l� Ja nna T mason 0 S ialist Cc: Inspector /Suspense Files Permit File ENC2016-00238 70. North First Street . Campbell, California 95008-1436 • TEL 408.866.2150 • FAx 408.376.0958 • TDD 408.866.2790 CRP VASONA LLC 4400 W. 78TH STREET., 4200 MINNEAPOLIS MN 55435''. - JoAnna Thomason From: JoAnna Thomason Sent: Monday, June 26, 2017 11:11 AM To: Carolina Vargas Cc: Doris Quai Hoi Subject: FW: 250 E Hacienda Ave Attachments: SD_SIDE_KON16120211400.pdf; SD_SIDE_KON16120214000.pdf; S D_SID E_KON 16120214010.pdf Hi Carolina, we just issued a deposit refund to Kier and Wright, but the payor was actually CRP Vasona not Kier and Wright. I was going by the name of the payor on the receipt when I completed the check request. Can we reissue the check to CRP Vasona? Kier and Wright is sending back the incorrect check, and I will send that to you as soon as I receive it. Attached are the copies of the check and receipt. Can you give me the check once it's reissued? Thanks JoAnna JoAnna Thomason I Office Specialist Public Works Department Joannat@cityofcampbelf.com Phone 408.866-2150 Fax 408.376-0958 70. N. First Street I Campbell, CA 95008 www.cityofcampbell.com From: Josh Gisi [mailto:jgisiCcbkierwright.com] Sent: Monday, June 26, 2017 10:39 AM To: JoAnna Thomason Cc: Doris Quai Hoi Subject: RE: 250 E Hacienda Ave JoAnna, Per the attached, the payor on the checklist and the check is noted as CRP Vasona LLC. Is the receipt the only documentation that you can use for the refund? Thanks, Josh Gisi jgisi@kierwright.com 1 408.727.6665 Please consider the environment: before printing this email. From: JoAnna Thomason[mailto:ioannat@citVofcampbell.com] k Sent: Monday, June 26, 2017 10:26 AM W To: Doris Quai Hoi <dorisgh@cityofcampbell.com> Cc: Josh Gisi <igisi@kierwright.com> Subject: RE: 250 E Hacienda Ave 1 A Doris and Josh, The receipt is in Kier and Wright's name. Finance will only refund a deposit to whomever the receipt is made out to. Kier and Wright will have to issue a check themselves to CRP Vasona. I am attaching a copy of the receipt for your reference. Thanks, JoAnna JoAnna Thomason PublicDepartment Joannat@citvofcampbe Lcora Phone 408.866-2150 Fax 408,376-0958 t N. First Street I Campbell,95008 From: Doris Quai Hoi Sent: Monday, June 26, 2017 9:22 AM To: JoAnna Thomason Subject: FW: 250 E Hacienda Ave JoAnna, See below. Kier and Wright said that CRP Vasona wrote the check. Can we get this reissued please. Thanks, Doris From: Josh Gisi[mailto;jgisi(c�kierw,right.com] Sent: Monday, June 26, 2017 8:50 AM To: Doris Quai Hoi Cc: 'Izumi, Sandy @ San Jose'; 'Patricia Hahler'; Mark Knudsen Subject: 250 E Hacienda Ave Doris, Kier & Wright received the check for 250 E. Hacienda Ave. We would like the check made out to CRP Vasona LLC and sent to Sandy Izumi in San Jose. Can you please reissue the check? Make check out to: CRP Vasona LLC 4400 West 78th Street, Suite 200 Minneapolis, MN 55435 Send to the Attention of. - Sandy Izumi, CBRE 225 W. Santa Clara Street, 12th Floor San Jose, CA 95113 Let me know if you have any questions. Thanks, k W Joshua Giisi I Project Engineer 2 pV ' Cq� °kcnnno CITY OF CAMPBELL Public Works Department June 20, 2017 Josh Gisi Kier & Wright 3350 Scott Blvd. Bldg 422. Santa Clara, CA 95054 SUBJECT: PERMIT NO. ENC 2016-00238 250 E. Hacienda Ave. FINAL INSPECTION AND ACCEPTANCE Dear Josh: The City of Campbell has made a final inspection of subject Public Works improvements and finds the work to be acceptable and in conformance with City standards. Accordingly, the City Engineer accepts the improvements. Your Plan Check Deposit in the amount of $500.00 is enclosed. If you have any questions, please call me at (408) 866-2150. Sincerely, Doris Quai Hoi Assistant Engineer Cc: inspector /suspense Files Permit File ENC2016-00238 70 North First Street • Campbell, California 95008-1436 • TEL 408.866.2150 • FAX 408.376.0958 TDD 408.866.2790 ........ . . ............ ............. . ........... .................................... ........ .......................... .......... . ...... .. ................. ............. .......................... ............ ............... - --------- ------------------------- -------- ---------- -------- ----- -- --------------- ------ -- -- ------ ------------------- -------------- ---------------------- rTTVi'nF (AMPRRT.L VENDOR NO. 10014419 CHECK NO. 263002 CITY OF CAMPBELL 701NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 KIER & WRIGHT 3350 SCOTT BLVD'., BLDG #22 SANT A CLARA CA 95054 Encroachment Permit # Address: 2y Encroachment Permit Final Sign Off �N C 2e1A.--0&2-S9 Date of Final Inspection and Acceptance: Inspected by: OK to release deposits: 100% 75% " Comments: Ts \GYI C Ne GY, ar J Refundaible . Deposit Check `Request To:. Finance Director .. Check Payable TO: South Bay Construction Address - Line 1: 1711-Dell Ave: _ Line 2`. City: Campbell , State: CA. Zip 95008 " Description: 250 -Hacienda Account Number: - 101.2203 Amount $231920.00- Account Number: 101.2203 Amount: Account Number: 101:540:7448 Amount: (Finance Dept only) lF terest Earned (Finance Dept. only) Total -Payable: (Exact Amount) Purpose, ENC2016-00238 -FPS & Emerg Cash Deposit Refund Permit #s, EN_C2016-00238 Receipt #: 268517 D"ate: 3/1`0/2017 Receipt #:, , Date: Requested by: -u Title: inspector pater $yed Wahidi J n Approved Approved Sr. Engineer Date: Ag City Engineer Date: Finance Dept Only: Verified by: Title: Accounting Clerk II Date: Approved by: . _ Title: Accountant Date: Simcial _ Instructions... For, -Hand-1 i:ng" Check (Mail As, Is: Mail in Attached_,Envelope: Interim Check: Needed By - Return' -To: JoAnnaThomason = Public Works (Name,) (Departinent) Other:_Please return check to JoAnoa 6 \� so -,J 51 S;_0 BOND FOR FAITHFUL PERFORMANCE ENCROACHMENT PERMIT NO. We, the undersigned CRP Vasona, LLC , (hereinafter "Principal ") and Liberty Mutual Insurance Company I a corporation organized under ' the ' laws of the State of Massachusetts and authorized to transact business in the State of California, as Surety, are obligated to the City of Campbell, (hereinafter "City") a municipal corporation under the laws of the State of California, in the sum of Twenty Three Thousand and No/100 Dollars ($ 23,000.00 ) for the payment of which sum we obligate ourselves and our successors and assigns, jointly and severally by the following provisions: The condition of this obligation is: Because the obligated Principal has, on VA 12017 , entered into written Encroachment Permit with the City for the Project, a copy of which Encroachment Permit is attached and made a.part of this bond, for construction of Project 210 and 250E Hacienda Ave Campbell CA 95008 , �i « --.� ENC-Zo\ le 66Z3$ Now, therefore, if the Principal shall faithfully perform the work in accordance with the plans, specifications and permit documents during the original term, and any extensions of the permit which may be granted by the City, with or without notice to the surety, and if it shall satisfy all claims and demands incurred under the permit, and shall fully indemnify and save harmless the City from all costs and damages which it may suffer by reason of failure to do so, and shall reimburse and repay the City all outlay and expense which the City may incur in curing any default, then this obligation shall be void; otherwise to remain in full force and effect, with surety obligated to secure the full and faithful performance of all of Principal's obligations under the attached Encroachment Permit. If any legal action be filed upon this bond, it shall be filed within one year after final payment has been made under the Encroachment Permit excluding the warranty period, if any, provided for in the Encroachment Permit, and venue shall lie in the County of Santa Clara, State of California, and that surety, for value received stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Encroachment Permit or to the work to be performed under it or the specifications accompanying it shall in any way affect its obligation on this bond, and it does by this means waive notice of any change, extension of time, alteration or addition to the terms of the Encroachment Permit or to the work or to the specifications, and thereby waives the provisions of Section 2819 of the Civil Code of the State of California. In witness, the parties have executed this agreement as of Match 31 (Attach Acknowledgements) (Both Principal's and Surety's Attorney in Fact) 2017 CRP Vasona, LLC (Principal) Titl Liberty Mutual Insurance Company (Surety) By Charissa D. Lecuyer, Attorney-in--Fac . Address of Surety: 175 Berkeley Street; Surety's Bond Number 674027292 (Accompany this bond with Attorney-in-fact's authority from Surety to execute the bond, certified to include the date of the bond.) MFORMSWemplatesTncroachment Pennits\Bond for FaithfulTerfonnance.doc (Rev. 03/08) PRINCIPAL ACKNOWLEDGMENT STATE OF Wall on COUNTY OF District of golumbia On C before me, -5 - CLLO a Notary Public in and for the above county, personally appeared S , who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her authorized capacity, and that by his/her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. IN WITNESS WHEREOF, I have hereunto subscribed by name and affixed my official seal,the, day and year first above written. 441 .. - ` dad � YExpires:Cj�vi� M Commission I cut-J, fi Signature Notary ;T ;, •;�yeAV�y'� Ij SURETY ACKNOWLEDGMENT STATE OF MISSOURI ) COUNTY OF JACKSON) On March 31, 2017, before me, Hannah N. Hicks, a Notary Public in and for the above county, personally appeared Charissa D. Lecuyer, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he/she is Attorney -in -Fact of Liberty Mutual Insurance Company, a corporation organized and existing under the laws of the State of Massachusetts, that the seal affixed to the foregoing instrument is the corporate seal of the said corporation, that the instrument was signed, sealed, and executed in behalf of said corporation by authority of its Board of Directors, and further acknowledged the said instrument and the execution thereof to be the voluntary act and deed of said corporation by his/her voluntarily executed. IN WITNESS WHEREOF, I have hereunto subscribed by name and affixed my official seal the day and year first above written. My Commission Expires: ,:SignaturE'��f •Notary HANNAH N. HICKS NOTARY PUBLIC —NOTARY SEAL STATE OF MISSOURI CASS COUNTY MY COMMISSION EXPIRES 10/5/2019 COMMISSION # 15437380 THIS'P OVVER OF ATTORNEY. IS -.NOT W ' ''INLESS_IT IS"PRINTED ON: RED-6ACkGRn'i�b This:Powerof Attorney limits4he acts of those.narned l andahey have -no authority to bind the -Company -except i iannerand to the extent herein stated - - Certificate No.'7652186. ,- - Liberty -Mutual Insurance Company- - Ttie.Otiio Casualty Insurance -Company We§tAmerican Insurance Company" - .:POWEROF ATTORNEY - KNOWN- ALL. PERSONS,BY THESE PRESENTS: That The Ohio- Casualty Insurance Company is,.a.corporation. duly organised under the'. laws: of the, State of New Hampshire; that Liberty Mutual"Insurance Company- is a corporation duly organized under the laws of the`State of'Massachusetts,- and: West, American. Insurance,Company_is a -corporation duly - organized -under the. laws of the State of Indiana (herein collectivel'y:called the"Companies");,pursuant to and, by authority.herern set forth does heretiyname constitutearid;appoint,- C.. Ste phens:Griggs .Chanssa D::Lscuyer, Charles R: Teter, III, Christy M>:Braile; Debra J.=Scarborpugh, Evan D Sizemore; Jeffrey-C.:Carey; L=arissa:- :- Smith; Laura-M. Buhrmester; Mary:T. Flanigan„Megan G.Bums_Hasty, Pattick-T:_Pribyh"Rebecca & cal, TafiitiaM :Fpc - = aft of he_city of='Kansas City state of MO: each Individually if there be more than one named; its true and lawful attorney in fact. o make execute;,seal acknowledge. _ _... Y and deliver, for. and on, its behalf -as suret and as:its act and:deed any -and a11'undertakings,"bonds tecognlzances and other surety_obhgatlons in pursuance of these:presents and shall be as,binding-upon_the Companies as if they have been duly signed by lhe.presiderit and'attested bythe secretary of the the in:their own proper persons - - _ - - - 7- IN-WITNESS-WHEREOF,` this Power of Altomey:fias been 'subscnbedby an authorized Deer or official of the Companiesand the corporate seals of the Companies have been affixed _ - - - `thereto -this 7th::- _day -of "March 2017 =. --, �4�Y Ili SUS, J \,.1NSUR,q�r : `\Yi1St?q, .:' ��✓ � - �- �. Ohlo Casualty Insurance Company rn Liberty Mutual Insurance Company ai 1919 t91L , 1991 �q _ UVestAmen can Insurance Company :y By. : ar•. W; $TATE.OF P,ENNSYLVANIA:` e etary4 " L COUNTY OF MONTGOMERY F ecr o David M Care Assistant 5 L Onahls -7th day of Marche 2017 before me ersoriall a eared Dawd M ^Care who:acknowled ed himself to be the Assistant Secreta: of Libert ;Mutual Insurance P Y PP Y _ 9 ry Y v e>> =Company The Ohio CasualtyyCompany;'und Nlest American Insurance Company; and that _he as such being authorized so to tlo .execute'the=foregoing)„Instrument for the puposes therein contained by signing on behalf of.the:corporations by himself as a dulyauthonzed officer ,CCC a> > IN WITNESS WHEREOF I have hereunto subscribed myname and affixed my notarial seafat, iqg of Prussia Pennsylvania'.on the day and yearfirst above wrdten 0= PasT COMMONWEALTH OF PENNSYLVANIA M otts�Cow Fa< ({ Nolartal Seal 0-: n, Y.. 7eresa:Pastella,,Notary Puhi�c - By _ N��t%GQ-� _ O i; Y LJA�,aG My Commissl n Ex� restMarc 28 2021 Teresa Pasfella Notary Publ c O d-'O_ = _ •- L \\ - �MemberPennsylvameAssocfationofNolanes •..0 _ �; This Power of Attorney,Is:matle and executed pursuant to::and by.authority of the following By laws and'AuthonzaUons_of The Ohio Casualty Insurance Company Libefty Mutua6 rA-p= y Insurance Company and West American Insurance Company which resolutions are now m full force and effectreadmg as follows - r , COW cc �- ARTICLE IV OFFICERS :Section 12:' Power cfAttorne An officer dr otfler..official of fhe Co oratioh-authonzed fDrthat: ur ose in writin b the Chairmanor the President andsub ect O cf ,- Y- y -,rP P P 9 y_ 1 a;: tosuchaimitahon as the Chairman orthe President may�prescribe'sliall a Dint-sucttattorile s m fact; as ma be necessa, to act in:behalf ofthe Cor oration to,make execute seal - O_-=; acknowledge and:dellveras surety any_;and all undertakings; -bonds iecognizances_and othersurety obligations: Such attorheys in fact subtect to'.the limitations set fortlian their respective .�._2 G: E powers `ofattorney;; shall have full power to brad the Corporation by their signature and execution of any suchinstrumentsand to attach thereto_the sealofthe Corporation When so p _ executed such".instruments shall be as:hinding as if sigbed:by the Presidentand attested to:by the Secretary Any -power or authorty granted to.ariy_representative or altomey in fact under `>r:= L' the provi"sions of this article maybe revoked at an .time b the Board the Chairman the President or.b the officer;or officers, rantin such owerbr authors ,ARTICLE Xilt _Execution ofContracts SECTION 5 Surety Bonds.and Undertakings ;Any officer ofahe Companyauthorized for that.purpose rn:wnfing by the chairman orthe-president andsubjectto uch.limitations, as the chairman or the presidentmay_p_rescnbeshall appointsuch attorneys in fact, as maybe-necessary_to.act in�behalf of thbe Company;to make execute M: _ : O'3 seal::acknowle8ge and deliver asau[ety any aad all untlertakings;,bonds recog'nizances\and othersurery;obligations Such attorneys m fact subject to the limitations set forth 4ir their s= a0 respective powers, of attorney, shall have full powerto bihtl the Company by their signature.and execution of.any such instruments and toattach ltiereto theseal of the"Company:UVhen so executedsucti instruments -shall be as bindmg as if signed: bythe president and atfested by the secretary -v cTo . _ _ _ 0 Certificate of=Designation -:The President of the, Company acting pursuant td the Bylaws.of the Company authorizes David M .Carey; Assistant•Secret _ _ f-c appointsuchattomeys m ~ r fact asmay be necessaryfo..act on behalf of the Company Q make execute `seal acknowledge and=deliver asaurety anyand all;undertakiilgs bonds ,recognizances and othersureiy obligations - - - _ Authorization - 8y unanimous"consent`of the Company s Board of Directors the Company consents that facsiinlle or mechanically reproduced signature of any assistar tseereiary of the Company, wherever=appearing.upon a certified copy of aRy power of attorneyissued bythe. Company._in connection with surety bonds; _shall be 4alyd andaihdmg:upon ttie Company with the:same force and -effect as though manually affixed I Renee--C-: Llewellyn, -the undersigned,: Assistani- Secretary; -The Ohio Casualty Insurance -Company; liberty Mutual Insurance Company and West American Insurance Company do hereby certifythat`the original power of altomey of-whtch:the'foregoing is a full :true and correct`copy:of:the Power -of Attorney executed by said Gompaniesis in full.force,and_effect and -has not been,revoked MAR 3-1.2017'' IN TESTIMONY WHEREOF; I have,hereuntoset my hand.and affixed_the seals of said Companies this day of. = 20 o 1919 a 1312 ' g 1197 : By: `n Renee C. Llewe ssfstant Secretary 315.of 500: LMS_12873_022017. ,;, Pli'oui; WORKS DEPARTMENT LAND utvtLUFMtr_'- Effective July 1, 2016 TO: Finance PUBLIC WORKS FILE Nr ENC 2016-238 PROPERTY ADDRESS 210 and 250 E Hacienda Ave Please collect & receipt for the following monies: ACCT.;ITEM AMOUNT 1 AN_DDEVELOPMENT ' 4122 Encroacriment Hermitpp lca ion ee Non -Utility Encroachment Permit Major>_$10,000 $403.00 Minor Encroachment Permit <$io,000 $230.00 Initial R-1 Permit N/C Subsequent R-1 Permits within Two Year Period $230.00 Inspection Fee Minimum Charge per Location $398.00 Street Tree Planting/Removal N/C 2203 ($500 per Tree Planting Deposit Required) $500.00/tree 22031 Plan Check Deposit 2% of Engineer's Estimate $500.00 min Utility and R-1 Permits no deposit required 4722 Grading & Drainage Plan Review Single Family Lot $281.00 Site < 10,000 s.f. $841.00 Site >_ 10,000 s.f. < 0.5 Acre $1,127.00 Site > 0.5 Acre $1,688.00 4722 NPDES Review (C3 Requirements) For projects not required to submit numeric sizing $163.00 $ 160.00 For projects required to submit numeric sizing Impervious Area 10,000 Sq. Ft to 1 Acre $704.00 Impervious Area 1 Acre or more $918.00 4722 For projects sent to Consultant for review Consultant Cost +20% 4722 Additional treatment facilities $300 ea Plan Check & Inspection Fee (Non-Utility)- 4722 Engr. Est. < $250,000 14% of Engineer's Estimate $ 3,220.00 4722 Engr. Est. >_$250,000 and _<$500,000 $35,000 + 8% of Engineers Estimate 4722 Engr. Est. >$500,000 $55,000 + 7% of Engineers Estimate 2203 Emergency Cash Deposit 4% of Engr. Est.* ($500 min/$10,000 Max) $ 920.Op 2203 Faithful Performance Security (FPS) 100% of ENGR. EST.* $ 23,000.00 2203 Labor and Materials Security 100% of ENGR. EST.* 4721 Storm Drainage Area Fee Per Acre R-1 $2,120.00 " (Multi -Res $2,385.00) (All Other $2,650.00) 4722 Parcel Map (4 Lots or Less) $4009.00 + 87/lot 4722 Final Tract Map (5 or More Lots) $4,871.00 + 118/lot 2203 Monumentation Security 100% of City's Monumentation Estimate 4920 Parkland Dedication Fee (75%/25% Due Upon Cert. of Occupancy) 4722 Lot Line Adjustment (Includes Certificate of Compliance) $1,893.00 4722 Vacation of Public Streets & Easements $2,530.00 4722 Certificate of Compliance $1,877.00 4722 Certificate of Correction $561.00 4722 Document Recording Fees $15.00/first page $3 ea. Additional 4722 Private Improvement in Public ROW $50.00 4722 Approved Plan Revision Fee $100/sheet 4722 Appeal Filing Fee $200.00 4722 Notary Fee (per signature) $10.00 4722 Assessment Segregation or Reapportionment First Split $895.00 Each Additional Lot $281.00 511.7424 MIS EC 7" Postage t - -.- EOUS" a Other (Please Specify) *Engineer's Estimate shall be as approvedbythe City Engineer and �sh-all include all items of work. TOTAL $ 27,300.00 NAME OF APPLICANT ( ✓n 7 C�JIS ((Z-lJ� l t O� r NAME OF PAYOR PHONE _I % Y"' 3 ta' ADDRESS �� C I LA C, A i'ip � S D�� FOR 4F7 RECEIVED BY, ITY CLERK ONLY Date Receipt #;BE :•. .: p6 (/' E� CAP pr�E J:LLsndDeNP Gh.kC •,.. :. .-: -• - - '' CITY OF G#ky qa : fbN I M YDR: SOUTH B6Y r 2l 0 Do026 »»»»s m±: mQ0/12 3S«R PATE: 03Q0/9 SCRmQm mA D;gU66= p Amy 9mamGq G1q;R PAD G: x«,m «tea ENm#mdq S[gGz mq G: q, Gee «ma RE` DEPOSSIr-!0, CUST q: 1.000 am.m EaEmaT-!% . � TOTAL DUE ��`�`— 7GqU: 9\ +Gm mU7=\7%m . epEDIT Gd: £m - 7Fmm «\+%m BOND FOR LABOR AND MATERIAL ENCROACHMENT PERMIT NO. We, the undersigned CRP Vasona, LLC , (hereinafter "Principal") and Liberty Mutual Insurance Company, a corporation organized under the laws of the State of Massachusetts , and authorized to transact business in the State of California, as Surety, are obligated to the City of Campbell (hereinafter "City"), a municipal corporation under the laws of the State of California, in the sum of Twenty Three Thousand and Noll 00 Dollars ($ 23,000.00 ) for the payment of which sum we obligate ourselves and our successors and assigns, jointly and severally by the following. provisions: The condition of this obligation is that the Principal entered, or is about to enter, into a certain written Encroachment Permit with the City dated .r-A 2017 which said Encroachment Permit No. is hereby referred to and made a part hereof. eiwe a01(a-oOz3'$ Because Principal is required to furnish a bond in connection with the Encroachment Permit, providing that if Principal, or any of its subcontractors, shall fail to pay for any materials, or other supplies, or for any work or labor on the permitted work of any kind, or for amounts due under the unemployment insurance act with respect to any work or labor on this project, the Surety on this bond will pay for the debt, in an amount not exceeding the sum specified in this bond, and also, in case suit is brought upon the bond, a reasonable attorney's fee to be fixed by the court. Now, therefore, we, CRP Vasona LLC , - as Principal, AND Liberty Mutual Insurance Company as Surety, are obligated to the City of Campbell, and all contractors, subcontractors, laborers, material men and other persons employed in the performance of the aforesaid agreement in the sum of Twenty Three Thousand and No/100 Dollars ($ 23,000.00), lawful money of the United States, for the payment of which sums will and truly to be made, we the said Principal and Surety bind ourselves, successors and assigns, jointly and severally, by these provisions. The condition of this obligation is that if Principal; its successors or assigns, or its subcontractor, or subcontractors, shall fail to pay for any labor, materials, or other supplies, used in the performance of the work permitted to be done, or for amounts due under the unemployment insurance act with respect to this work or labor, then the Surety on this bond will pay for them, in an amount not exceeding the sum specified in this bond, and in case suit is brought upon this bond will also pay a reasonable attorney's fee, to be fixed by the court. Venue for any action arising out of this obligation shall lie in the County of Santa Clara, State of California. It is expressly stipulated and agreed that this bond shall inure to the benefit of any and all persons, companies 'and corporations entitled to file claims under Title 15 (commencing with Section 3082) of Part 4 of Division 3 of the Civil Code, so as to give a right of action to them or their assigns in any suit brought upon this bond. Should the condition of this bond be fully performed, then this obligation shall become null and void, otherwise it shall be and remain in full force and effect. No prepayment or delay in payment and no changes, extensions, addition or alteration of any provision of said Encroachment Permit or in any plans and specifications referred to herein, and no forbearance on the part of the City shall operate to release the Surety from liability on this bond, and consent to make such alterations without further notice to or consent by the Surety is hereby given; and the Surety hereby waives the provisions of Section 2819 of the Civil Code of the State of California. In witness, the parties have executed this agreement as of March 31 , 20 17 (Attach Acknowledgments Both Principal's and Surety's Attorney in Fact) CRP Vasona, LLC (Principal) Ti Liberty Mutual Insurance Company (Surety) Charissa D. Lecuyer, Attorney-in-Factt Address of Surety: 175 Berkeley Street Boston MA 02116 Surety's Bond Number 674027292 (Accompany this bond with attomey-in-fact's authority from"Surety to - execute the bond, certified to include the date of the bond.) M JAFORMSUemplates\Encroachment Permits\Bond for Labor & Materials.doc (Rev. 03/08) PRINCIPAL ACKNOWLEDGMENT STATE OF 'Washington, COUNTY OF District of Co umbia On APF'o, 0:5 ao�� , before me, S . Pik a Notary Public in and for the above county, personally appeared ,`FAIMCS �'� . Ui11t114�who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her authorized capacity, and that by his/her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. IN WITNESS WHEREOF, I have hereunto subscribed by name and affixed my official seal the day and year first above written.R My Commission Expires: Signatureof Notary STATE OF MISSOURI ) COUNTY OF JACKSON) C, 4 - ,a - Yost SURETY ACKNOWLEDGMENT On March 31, 2017, before me, Hannah N. Hicks, a Notary Public in and for the above county, personally appeared Charissa D. Lecuyer, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he/she is Attorney -in -Fact of Liberty Mutual -Insurance Company, a corporation organized and existing under the laws'of the State of Massachusetts, that the seal affixed to the foregoing instrument is the corporate seal of the said corporation, that the instrument was signed, sealed, and executed in behalf of said corporation by authority of its Board of Directors, and further acknowledged the said instrument and the execution thereof to be the voluntary act and deed of said corporation by his/her voluntarily executed. IN WITNESS WHEREOF, I have hereunto subscribed by name and affixed my official seal the day and year first above written. My Commission Expires: i HANNAH N. HICKS NOTARY PUBLIC -NOTARY SEAL STATE OF MISSOURI CASS COUNTY MY COMMISSION EXPIRES 10/5/201 c COMMISSION# 15437380 _ ... THIS -POWER OF-ATTORIIIEY IS,;NOT VA'-'^'-INLESS IT IS-PRINTED,OR RED BACKGR7bNQ This Power of Attorney:limits the acts -of -those -named t and they have no authority to bind the Coripanyexcept ii anner andao the.extent herein stated . _ - - - :._ r .. : -. _ Ce _ - - - - - .,- - . Liberty Mutual insurance Company" ,,, Ilea e ,, The - _ Ohio Casualty, Insurance Company :. ,- ;WestAmerican Insurance Company - - = - - . - " - - - - - . Po�V�R OF ATT�R6V� _ ... . ---. _- -. . KNOWN AL-L, PERSONS: BY THESE --PRESENTS: That The.Ohio Casualty" Insurance Company is., a corporation duly organized -under the laws of the State of New-Hampshirethat -'- --Liberty Mutual Insurance Company ,is a' corporation duly_ organized' under the laws of the: State of Massachusetts; and'WestAmencam lnsurance:Company isa corporation duly_ . .:. - organized underthe laws of the. State of Indiana -.(herein collectively called the. "Companies'), pursuantto and by authority herein set forth; does_hereby-name constitute and=appoint . C Stephens Griqqs Charissa=D` Lecuyer• Charles R Teter .Ill; -Christy M :Braile;-Debra J .Scarborough Evan:.D. Sizemore :Jeffrey-C. Carey;, Larissa = Smith Laura M: Buhrmester-Mary T, Flanigan -Megan L.;,Burns-Hasty, Patrick-T. Pribyl;:Rebecca S;_L'.eal Tapitia Nt Fry. = . - - .. - ,state of:MO - each lndividuall !f there be rnore-than.one. named, its true aiid lawful. attome Iq factto make; execute, seal; acknowled '_ all of.the city of Kansas City" " Y.% _ Y 9 _ and"deliver; for and on its behalf as surety and -as -its act anddeed anyand.all undertakings, bonds eecognlzanees and ottief surely olingatlons in pursuance:of tfes'e presents and shall - - ., be asbinding upon the Companies asif they have been tluly signed byahe.president and'attested by the secretary: of the Companies ln; their overt l r -persons _ _ _ - ., - - w.. _ .. IN WITNESS WHEREOF, this Power of Attorney fas beEnaubscnbed.by an atthonzed officer orofficial of the Compenies:and the corporate eals.of the Companies; have been affixed thereto this 7th' dayof Marctr: 2017c = - �'C:Y Ih,0 = �INSNq�, `~: a\1❑St/t{,q - �P µv,r R, 10� �I o,r„�� v 4 ro The:Ohlo Casualty Insurance Company ;N I. 19.9 �� :_ Llbert MutuallnsuranceCompany (: x ' s i�1z b 799t � - WestAmerican InsuranceCompany _ s _ U), N'" �S w" t��a - u�) TtA rw t r Wni n < _ m - _.. , _ -!p -w = David=M Carey,--AsslstantSecretary ='C' By " r- -STATE OF PENNSYLVANik' as:; ia: - _ . _. _ _ _ _ _ - COUNTY OF:MONTGOMERY A t`u - - - - - ^: : _ j _ ✓ ` C; `_ On this 7th . ,- day of March 20i7 before;me personally appea-red David M,Carey who acknowledged himself to be'the Assstant Secretary of Liberty Mu- I Insurance -cc }- v_'L. Company The .Ohio CasualtyCompany; and WesYAmericaminsurance'Company;and-that: he as such being authonzed"so to do execute the foregoing )nstrument;for the purposes- AU: 0 thereiacontained ti si nin on behalfof:ihe cor orations b himself as;a`dul authonzed "officer � = -� d W O - Y 9 9 .. P- y Y d r> IN WITNESS WHEREOF I have hereunto subscribed my name and affixed mynotanal seal atKing of Prussia Pehrisylvama on the day and year fast above written =0=fl. - �p .,Ps p - ALTN OF:PENNSYLVANIA Q M S - COMMONWE r0. 04ognoNw���`°,C _.'Notanal,Seal ' _ ` C 'y, `V ;, U :s ,, Teresa Pastella Notary Public BY aa// _L $: �` Y O ",- off'` Up erMeno_nTw Mcnt Dine .County TeresaPastella NotaryPubllc 4 'O :r. ,' . " , - : v -My C�mmtssion Expires March 28`2021 _ ; f0. ` �_.� d lPt` �:' O .` - °`Cl ". ��G Mefnbcer Pennsylvania Association ofNotane - _ '� >& -0 �� . �.,, _ .. ;:.i _ ,"= _; tt; This Power of Attorney tsrmade and executed •pursuant .. d.by. authontyof the following By laws and=Authorizations`; of The Oliio Casualty Insurance. Company Uberty_, Ltual w0) Insurance Company and WestAmerican Insurance Company which resolutionsare noav in -full force and effect reading as follows _ , J � C. aj:M. - - .. r �✓ i ++ _ w -a m =d- -ARTICLE IV OFFICERS -Section 12' PowerofAttorney A"I officer or -other official of the Corporatlon.authonzetl:for that purpose m writing byre e Chauman:or the President an&subiect O - i t ; to suchai- .- ion:es the Chairman or the President may prescribe stiall appointsuch attorneys !n.fact, as maybe necessar-y to act m.behalf ofthe Corporation to make execute seal ;�. ;Z, O_;= 'a knowled a and:(eliver:as:su et any.bnd alGunderlakm s, b'onds :reco nizancesand'othersurery.obligations -'Such:attorrieys in fact; sublectto,the limitations set forth m their respectve-; ' 9 - ' Y .. Y 9., 9 -: ,powers -of attorney-shall;have full power to bmd_the Corporation by_their signature and:execution:ofany sucti instruments=and ,to attach therefoahe seal=of the CorporationWhen so- r a) l p_ �: =executed such"instruments_shall e-as bmding_as if signed by:the;President-and-attestedao_by the Secretary Anypower or authontygranted to anyrepresentat-- a or attorney m fact under => =.1 .,L, _ _ o. the provisions of this article may be revoked at anytime by the Board afie Chairman the President or by the officer 6. officers -granting such power -or authority ;= It_ a :_ ;ARTICLE XIII -Execution of Contracts SECTION 5 Surety,Bonds and Undertakings: Any officer.ofahe Company authonzed for thatpurpose In wrlting by the chairman or the,pFesiderit;; - :� _ _,- > ;4and subject to sbcR-limitations as the clialrman or the president may pr escnbe Snell appointsuchattorneys in fact, as maybe:necessary-to actin behalf;of the Company,to make,=_execule L M O_ M.'seal; acknowledge,:and deliver as surety any and all undertakings bonds recognizances.and othersurety obligations Such attorneys In factsublecf to the limitations set forth an their _A- Z':v. respective powers'of attorney; shall heve full power'to bind the Company.bytheir-signature:and-executionof anysuch instruments and•to:attach thereto the seal of the Company:.When so. 409 executed such -I sstrumentsshall be as.)finding as]i ,signed by the president and attested by.the secretary - v-cfl= - O �_ F- r. Certificate of Designation =The President of the Company.::artmg pursuant to the BYlaws:of the Company authorizes David M Carey Assistant:Secretary::taappoin(such attorneys m s- _ _ _. "factas may be necessary to'act on behalf of the=Company to make execute _seal acknowledge and deliver asaurety any;and all undertakings :bonds recognizances and other surety ; _ ".obligations :. _ - ,. - `Auttiorizatwn=6y_unanimous consentof the:Company s Hoard of Directors -the Company.consents that facsimile or mechanically reproduced signature of any assistant secretary ofthe -. _ - ._ - Company wherever appearing upon. a:certified copy of any`power of attorney issued by the:Comp)ny-in connection with suretybonds;shall be valid and b nding'upon;the-Companywlth - the"same; force and effect;as though manually affixed = _ - - - 1; Renee-C. Llewellyn the, undersigned, Assistant Secretary,`The Ohio=Casualty Insurance. Company,: Liberty fvlutual Insurance Company ono West American Insurance"Company do hereby certify"thatahe,orlginal. power of attomey of whichahe foregoing rs a full true and correct copy, of -the Power of Attorney executed . sold Companies„is in full force and -effect and:. .,has notbeen revoked -, - �: V2� MAR 4J1t IN:TESTIMONY WHEREOF'I have hereunto setmy hand and affixed= the seals.of'said Companies this" day of - 20 - . .y1Y [Vs, iW5t:q �ii•l5ti{H - .. - - - - - _ - v,J��ca:ctrF�91m 1JQ�'r,a w�c. rAo - - J ev w 'C.. - - rele o 1912 ° 1997 ro BY ,. ; _Renee C. Llewe Assistant Secretary- >: - _ " :3"14 of 500; -- : CMS_12873_022017: - - No STATE OC: 3F A LMO DEPpRThONT OF INSURANCE SAN FARI MSCO AMM= Certificate of Authority Tong is "C=nrrx, rbxf, pjH¢rraaw to for la#.r vmee Coda of for State of ctllfors. t4wm%v3 Nwr= xvamtAw= cazm%NX of DDSTO.Y, K&ZaPLC=m= ' , oagmwkic d wodpr l6v lauW of XWSA'amom 6, , ,mb jm4 f =o its Areuslas of b#aorpoRatka o► ot�trr fusad.:�rs.ee! er�e►ti�t ,+arl docaw#„rti� is bc►eby mutbarixd to trmuAct U*Ib to Mis stal0,4xbjrat tosR�proulsaPlsOf iidsCgrllfccvsts.lba follosui► +Terns of issctt�rah+er. FIRE, ZASIVE. SAPS[. orA88. r-TA9lml=, WOW=Ei83 COw4ntSATXOx,- ccmOil' Cl�iR22aA T.YARILz'.t^l, BO T= AID VAOHVM=, ISIM"ART. e?A8i]Y'J.', SPRXMMER,. 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Xgm �.. sax�ax z�ooa�L WX 2- lO WJO 4" ' 2 5o F 4^& ett,4DA Syed Wahidi From: Syed Wahidi Sent: Friday, May 26, 2017 11:28 AM To: 'Marco Velasco' Cc: John Burchfiel; Randy Sargenti Subject: RE: Vasona Tech - Dell Ave Replacement Street Lights Hi Marco, The new tree installed is 15" box and not 24" as required per plans. Pease have it replaced and the tree need to be inspected for quality before it's installed. Please have your sub call me at my cell 408-425-4704 when tree arrives and I will have it inspected. Thanks. Syed Wahidi I Public Works Inspector Cily ref 6'�iinpbell j Public Works Dept. syedei (&kith ofcaani)bell.com -6ii'3.N'O().2 i 65 ^r5 408.3770-0`)a8 SirLct j C.':antpbell, C'A 9-50018 wNvw.CitvofCampbell.com From: Marco Velasco [mailto:mvelasco@sbci.com] Sent: Tuesday, January 31, 2017 5:00 PM To: Syed Wahidi Cc: John Burchfiel; Randy Sargenti; Bryce Rocklage; David Mooso Subject: RE: Vasona Tech - Dell Ave Replacement Street Lights Syed Bryce will be calling you to schedule and review the install of the lights. Thanks, Marco Velasco, t.EEDAP Project Manager South Bay Construction T: 408-874-2228 C: 408-768-4815 From: Marco Velasco Sent: Monday, January 30, 2017 4:10 PM To: 'Syed Wahidi' <SyedW@cityofcampbell.com>; David Mooso <DavidM@cityofcampbell.com> Cc: John Burchfiel <johnb@cityofcampbell.com>; Randy Sargenti (rsargenti@sbci.com) <rsargenti@sbci.com>; Bryce Rocklage <BryceR@newageelectric.com> Subject: RE: Vasona Tech - Dell Ave Replacement Street Lights There is a total for 4 lights being replaced. 1 Marco VelaSCo, LEEOAP Project Manager South Bay Construction T: 408-874-2228 C: 408-768-4815 From: Syed Wahidi[mailto:SvedW@citvofcampbell.com] Sent: Monday, January 30, 2017 7:11 AM To: Marco Velasco <mvelasco@sbci.com>; David Mooso <DavidM@cityofcampbell.com> Cc: John Burchfiel <iohnb@cityofcampbell.com> Subject: FW: Vasona Tech - Dell Ave Replacement Street Lights Dave, Please check out the light submittal for new light at 1315 Dell Ave. Marco, How many new lights to be installed? Syed Wahidi I Public Works Inspector Cate' of C:ampl e'll I Pl!blic 'Atoi-ks Depi. sye(iw(a)citvoi'campbell.com E 408.i 06.2 ; 65 4, 08.3 76-! 958 10. N. First C:.!: q hell. CA 95008 wee ev.CitvofCamebel l.com From: Marco Velasco [mailto:mvelasco@sbci.com] Sent: Thursday, January 26, 2017 3:03 PM To: Syed Wahidi Cc: Summer Olson -Todd; Bryce Rocklage; Randy Sargenti Subject: Vasona Tech - Dell Ave Replacement Street Lights Syed (408-866-2165) Attached is the for record submittal, it is the light that is listed on the approved drawings. Permit # ENC2016-00067. New Age (Bryce 669-333-6599) will be contacting you direct with any questions and to review the work. Thanks, Marco Velasco, LEED AP Project Manager PH (408) 874-2228 1 CELL (408) 768-4815 1 FX (408) 379-3256 S(ODUTH JA i 1711 DELL AVENUE CONSTRUCTION CAMPBELL, CA 95008 A REPUTATION BUILT ON TRUST. 408-379-5500 7 •. fit. S E' S jY (i COST 9j}SBE 7' RA ['S G g'q 6',� tti( 'f t\Lft`5��,s1�[,L•_ �R �'.t�il.�ai`� 10 t`V€ D IP11Qi'v1_ 9iUWKSBUCUM If you have received this e-mail in error, please notify the sender immediately by reply e-mail and pennarrently deteie this e-marl a!idn av attachments without reading, forwarding or saving them Do not share, copy, or otherwise use or disclose its contents. - 250 F1^e r � Syed Wahidi From: Syed Wahidi Sent: Tuesday, May 16, 2017 11:32 AM To: 'Marco Velasco' Cc: John Burchfiel; Roger Storz; Bob Siudzinski; David Mooso; Alex Mordwinow; Syed Wahidi Subject: RE: 250 E Hacienda - List of Remaining Work Attachments: IMG 0294.JPG Bob, Can you please check this 24" box "Ginko Biloba" tree installed just south of Dell/Hacienda corner. Tree was supposed to get inspected prior to installation but they never called us. Pic attached. Marco, What's the status of street lights upgrade? Syed Wahidi I Public Works Inspector C.ily of Campbell I Public worlis Dept. syedw(a;.citvol'cainpbell. com 2 408.866.2165 1 A 408.376-09-58 70. N. Firsi Street I Canipbell, C:A 95008 wwx .CityoPCampbelIsom From: Syed Wahidi Sent: Tuesday, April 11, 2017 7:23 AM To: 'Marco Velasco' Cc: John Burchfiel; Roger Storz; Syed Wahidi; Bob Siudzinski; David Mooso Subject: 250 E Hacienda - List of Remaining Work Hi Marco, Here is a list of the remaining work on this project: - Install one 24" box "Ginko Biloba" on Dell Ave (Tree to be inspected by city arborist prior to installation) - Upgrade four(4) existing street lights per plan (city electrician to do final inspection) Please let us know the schedule of work. Thanks. Syed Wahidi I Public Works Inspector C;ify of Canipbell I Public Works Dep(. svedwQ)citvofcarnpbell.com 9 408.866.2165 ( A, 408.376-0958 '0. N. I-irst Street I Carupbell, CA 95008 www.CitvofCamr)bel I.com From: Syed Wahidi Sent: Friday, February 17, 2017 10:20 AM 1 To: 'Marco Velasco' Cc: John Burchfiel; Roger Storz Subject: RE: Vasona Tech - Dell Ave Replacement Street Lights Hi Marco, The ADA ramp pavers are installed incorrectly as shown in the attached picture. City uses ADA 2-60 Terra Pavers as called out in the approved plans. Please have them corrected. Thanks. Syed Wahidi I Public Works Inspector City of Campbell I Public Works Dept. svedw(&cityofcam1)be1l.com 12 408.866.2165 AQ 408.376-0958 70. ti. First Street Campbell, CA 95008 www.CitvofCampbel Isom From: Marco Velasco [mailto:mvelasco@sbci.com] Sent: Tuesday, January 31, 2017 5:00 PM To: Syed Wahidi Cc: John Burchfiel; Randy Sargenti; Bryce Rocklage; David Mooso Subject: RE: Vasona Tech - Dell Ave Replacement Street Lights. Syed Bryce will be calling you to schedule and review the install of the lights. Thanks, Marco Velasco, LEEDAP Project Manager South Bay Construction T: 408-874-2228 C: 408-768-4815 From: Marco Velasco Sent: Monday, January 30, 2017 4:10 PM To:'Syed Wahidi' <SyedW@cityofcampbell.com>; David Mooso <DavidM@cityofcampbell.com> Cc: John Burchfiel <iohnb@citvofcampbell.com>; Randy Sargenti (rargenti@sbci.com) <rargenti@sbci.com>; Bryce Rocklage <BryceR@newageeiectric.com> Subject: RE: Vasona Tech - Dell Ave Replacement Street Lights There is a total for 4 lights being replaced. Marco Velasco, LEEDAP Project Manager South Bay Construction T: 408-874-2228 C: 408-768-4815 2 Syed Wahidi From: Syed Wahidi Sent: Tuesday, April 11, 2017 7:23 AM To: 'Marco Velasco' Cc: John Burchfiel; Roger Storz; Syed Wahidi; Bob Siudzinski; David Mooso Subject: 250 E Hacienda - List of Remaining Work Hi Marco, Here is a list of the remaining work on this project: - Install one 24" box "Ginko Biloba" on Dell Ave (Tree to be inspected by city arborist prior to installation) - Upgrade four(4) existing street lights per plan (city electrician to do final inspection) Please let us know the schedule of work. Thanks. Syed Wahidi I Public Works Inspector City ;if Campbell I Public Works Dept. syedia (a.:citvofcamt)bell.com 40S.866.210r T ,'-1, 108,376-09�8 70. N. first Street i C'a1r111A)CIL CA 95008 www.Citvol'CamDbell.com From: Syed Wahidi Sent: Friday, February 17, 2017 10:20 AM To: 'Marco Velasco' Cc: John Burchfiel; Roger Storz Subject: RE: Vasona Tech - Dell Ave Replacement Street Lights Hi Marco, The ADA ramp pavers are installed incorrectly as shown in the attached picture. City uses ADA 2-60 Terra Pavers as called out in the approved plans. Please have them corrected. Thanks. Syed Wahidi I Public Works Inspector City of Caurpbell I Public Works Dept. syedw�.citvofca►npbell.com 408.866.2165 408.376-0958 70. N. First Street C:anrpbeli, CA 9-5008 www.CityofCarnpbel Isom From: Marco Velasco [mailto:mvelasco@sbci.com] Sent: Tuesday, January 31, 2017 5:00 PM To: Syed Wahidi Cc: John Burchfiel; Randy Sargenti; Bryce Rocklage; David Mooso Subject: RE: Vasona Tech - Dell Ave Replacement Street Lights Syed Bryce will be calling you to schedule and review the install of the lights. Thanks, Marco VelaSCo, LEEDAP Project Manager South Bay Construction T: 408-874-2228 C: 408-768-4815 From: Marco Velasco Sent: Monday, January 30, 2017 4:10 PM To:'Syed Wahidi' <SyedW@cityofcampbell.com>; David Mooso <DavidM@cityofcampbell.com> Cc: John Burchfiel <iohnb@citvofcampbell.com>; Randy Sargenti (rsargenti@sbci.com) <rsargenti@sbci.com>; Bryce Rocklage <BryceR@newageelectric.com> Subject: RE: Vasona Tech - Dell Ave Replacement Street Lights There is a total for 4 lights being replaced. Marco Velasco, LEEDAP Project Manager South Bay Construction T: 408-874-2228 C: 408-768-4815 From: Syed Wahidi[mailto:SvedW@cityofcampbell.com] Sent: Monday, January 30, 2017 7:11 AM To: Marco Velasco <mvelasco@sbci.com>; David Mooso <DavidM@cityofcampbell.com> Cc: John Burchfiel <iohnb@citvofcampbell.com> Subject: FW: Vasona Tech - Dell Ave Replacement Street Lights Dave, Please check out the light submittal for new light at 1315 Dell Ave. Marco, How many new lights to be installed? Syed Wahidi I Public Works Inspector City or Campbell I Public Works Dept. svcdw(a).citvofcampbell.com W 408.866.2165 1 � 408.376-0958 70. N. First Street j Campbell, CA 95008 WWW.CityofCmp abel I.com From: Marco Velasco [mailto:mvelasco(a)sbci.com] Sent: Thursday, January 26, 2017 3:03 PM To: Syed Wahidi 2 • r Cc: Summer Olson -Todd; Bryce Rocklage; Randy Sargenti ' Subject: Vasona Tech - Dell Ave Replacement Street Lights Syed (408-866-2165) Attached is the for record submittal, it is the light that is listed on the approved drawings. Permit # ENC2016-00067. New Age (Bryce 669-333-6599) will be contacting you direct with any questions and to review the work. Thanks, Marco Velasco, LEED AP Project Manager PH (408) 874-2228 1 CELL (408) 768-4815 1 FX (408) 379-3256 9 ! z} Im 1711 ®ELL AVENUE CONSTRUCTION CAMPBELL, CA 95008 A REPUtATION BUILT ON TRUST. 408-379-5500 THE SBC COST SEEERENCE BRIDE AID 3;yr i C,'t+:' ,!¢,IL} 03`4ANIDROIDANOIPd()N t z WUMSBUCOM If you have received this e-rnail in error. please notify the sender immediately by reply e-mail and permanently delete this e-mail and any attachments without reading: forwarding or saving them. Do not share. copy, or otherwise use or disclose its contents. 3 ENC;_ 'CHMENT PERMIT ISSUANCE CHECK C City of Campbell Encroachment Pern it No. ENt 2016-238 Department of Public Works Tract No. Address 250 E Hacienda Ave ITEMS REQUIRED FOR PERMIT 1. ED Encroachment Permit Application complete, with applicant signature and date (front and back) Y� J 2. 0 Permit Application Fee paid $403.00 Receipt Number & Date: t� 70k. f 2,/ 2' / V 3. E Plan Check Deposit Paid (2% of Engineer's Estimate, $500 nun) $500.00 Receipt Number 4. 0 iPGrading Plan Review Fee paid $0.00 Receipt Number & Date: 5. 2 City Engineer's Estimate Completed and Submitted 6. 121 Four (4) Sets of Street Improvement Plans 7. ❑ Four (4) Sets of Grading and Drainage Plans 8. O Check Lists (Grading and Drainage, Street Improvement) ITEMS REQUIRED PRIOR TO PUBLIC WORK CLEARANCE FOR BUILDING PERMITS ❑ Plan Check & Inspection Fee: Engineer's Estimate (EE) $23,000.00 ; if EE is <$250,000, then fee is 14% of EE. If EE >_ $250,000, fee is Actual Cost + 20%. $35,000 minimum deposit. Amount 1$3,220.00 Receipt No. & Date ❑ Security for Faithful Terfonnance and Labor and Materials, 100% each of Engineer's Estimate, supplied or paid. Amount: $23,000. 0-0-1 Form: Receipt No. & Date: 11. }Security for Monumentation Amount: $0.00 Receipt No. & Date: 12 ❑ Construction Emergency Cash Deposit: 4% of Engineer's Estimate. ($500 minimum, $10,000 maximum) Amount r $920.00 Receipt No. & Date 13. Storm Drainage Area Fee Amount $0.00 Receipt No. & Date n4. ❑ Street Improvement Agreement signed and notarized (proof of ownership submitted) 15. ❑. Right of Way Documents Completed and Fees Paid. p PSE & S/W Easement ❑ Strebt Dedicate ❑ R.O.S. Req'd? 16. ❑ All other Public Works requirements listed in the Conditions of Approval of the development. 6 ' PG & E App (SQ 17.- ❑ Other Fees, Payments, Deposits Amount 1 $0.001 Receipt No. & Date C" 23. ❑ Contractor's signature added to the pernut application (front and back) 24. ❑ Contractor's City of Campbell Business License # 0 25. ❑ Worker's Compensation Insurance Information Sheet received from Contractor. 26. ❑ Certificate of Insurance with Additional Insured's Endorsement received from Applicant or Contractor. 27. ❑ One mylar set and six (6) or less sets of off -site plans signed by engineer, stamped APPROVED FOR CONSTRUCTION. ❑ Contractor ❑ Inspector ❑ PW Superintendent (Service Center) ❑ EP File ❑ LD File ❑ Signals & Lighting Supervisor (Service Center) 28. ❑ Permit signed by City Engineer. 29. ❑ INITIATE CHECK REQUEST FOR PLAN CHECK DEPOSIT REFUND WHEN ALL OF THE ABOVE ITEMS ARE COMPLETE, PERMIT MAY BE ISSUED. Issuer: Initial and date and file with permit J:\LandDev\Plan Check Convnents\1 - Specific Projects - Active Project in Proo -ess\Hacienda Ave 250\[Fees.xlsm]6-ENC Permit Issuance Checklist � ;I I � I - � Uf_ :x[i paualsag i , U I - I j I i I # , � � IV9S LZL (900 XPJ I t,SOS6 efuJOIlIP:) 'PJPI:) PlueS I IRCZ00-9TOZ *ON JUNZ151d JjNaWHDVOZj3Na il 4 �: I I [., - 1'� "I i . .0 �_N��Mll i S999 LZZ (900 ZZ 6ulplIng 1pj*eA;alnog UOIS OSEE ii . i . I � I � � I i� aaavd I aAV V(INaIDVH *2[ 09Z ��' � i I or :S&r umv.ra ii I 1 - I , i f *:)NI 'SlI0A3Mns,pSS33NIDN3 IIAD I ; I � I :1 I - I I li . i� I I 'I- ''I I- jj 1� r4lis ddo SNVrTd INHINHAOUdWI 1HRUIS . ,�� - i� � L � ___I_i� I . j � I . i, IHDI"d*'M'? 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